DE10008917A1 - Arrangement for monitoring and localizing patients - Google Patents

Abstract

An arrangement (1) for patient monitoring is provided with at least one body sensor (2a) for recording a physiological parameter as well as a body signal processing unit (3) connected downstream of this and / or a therapy device (2) designed to act on the patient (P) and one for Data transmission from the body signal processing unit or the therapy device to a monitoring center (1C) and / or from the monitoring center to the therapy device designed mobile radio terminal (7) which can be operated in a cellular mobile radio network (1B). A base station coordinate storage unit (13; 13 ') and a position determination unit (12; 12.1' to 12.3 ') connected to it serve to roughly determine the patient's location based on position information obtained from the current base station connection of the mobile radio terminal in the mobile radio network. DOLLAR A A direction finder transmitter (300) which transmits a direction finding signal is provided in the mobile radio terminal (7) for determining the fine position. A locating device (310), which is separate therefrom, is used for fine locating the direction finding signal.

Description

The invention relates to an arrangement for patient monitoring according to the preamble of claim 1.

With serious health disorders or after major medicine interventions, for example after an early heart transplant early detection of a possible rejection reaction is a longer one continuous monitoring of the patient's condition shows. With a view to the quality of life of the person concerned, but also from Ka For reasons of capacity and costs, this should take place outside a clinic.

Also for people with implanted medical electronic devices, such as from Pacemakers, in some cases, is the constant monitoring of the Condition of the patient or the device required and as a rule at least the possibility of an immediate signaling of life threatening conditions of the patient or the device, associated with the simultaneous determination of the patient's whereabouts, wün worth it.

There are a large number of known arrangements for various applications conditions for non-inpatient patient monitoring.

In US 5 626 630 A1 is a with an implantable quasi-passive Medical telemetry system working transponder described that next to the transponder, a relay to be worn on the patient's body device and includes a remote monitoring station.  

DE 197 58 939 A1 describes an arrangement for patient monitoring described in which a patient device automatically in response to a certain position of the patient for data transmission to a central Monitoring point, especially via a telephone network, is activated.

WO 97/00708 A1 describes an advanced, very complex System for worldwide patient localization and data transmission from implanted devices to suitable evaluation points. To Be the patient's geographic position based on the satellite navigation system GPS, the system includes a special receiver, that the patient carries with them.

The patient is determined in the same complex manner position in the cardiac stimulation system with extended communication and monitoring options according to US 5 720 770 A1, which are in practice also use the landline or a mobile phone network for the transmission of relevant data.

In the applicant's German patent application 198 44 296.3 there is one Arrangement for patient monitoring and localization disclosed that with the participation of a mobile device based on a cellular Ren mobile network, such as. B. the GSM network is operated. Thereby fin detects a rough position determination with the help of a base station coordinate ten storage unit and a rough position connected to it Determination unit instead. The localization method there is based then to determine the position of the patient in a cellular mo bilfunknetz position-relevant information constantly available internally  to use and on separate means for geographic positioning na to renounce.

This idea is based on the one hand that the operator of a mobile radio network the geographic coordinates of all base stations used are present and each registered device is of course in the send and Reception area of at least one base station, but usually more base stations at the same time. At the placement level of the Mobile radio system also has information about which Ba sisstation it is so that an approximate location of the Patients based on the base station position record is possible.

It is also implemented in a modern mobile radio system the automatic transfer of connections between different base stations tion ("handover") including measurements of the signal propagation time min least to the currently active base station for the terminal concerned, so that in the system with the runtime information another position-relevant In formation is present. In the event that at the same time the shortest run times to several neighboring base stations can be measured from their position data and the associated runtime values very precise two-dimensional determination of the location of the concerned Device and thus the patient. The runtime data can Depending on the specific organization of the network, on the end devices or at the Base stations and possibly also on the switching level are queried.

Finally, the fact that the base stations usually work with directional antennas, a way to refine  Position determination of the patient by determining and evaluating with which antenna of the base station the connection with the patient Terminal is held.

The above position determination measures have - also in In the case of transit time measurements - the disadvantage that the spatial resolution is single Lich in the order of 10 to a few 100 m depending on the Cell size of the cellular network is. This spatial resolution regarding the Position of people in an emergency is close to them delte areas, such as B. inner city areas with multi-storey more family houses or commercial buildings, and confusing menus crowds, as at large events, too coarse for a quick opening find the person concerned. This also applies analogously to very large ones Cellular cells, such as on the mountains or in the country.

To solve this problem, the invention now proposes, in addition to Coarse position determination known from the prior art Monitoring arrangement through a three-dimensional fine position To add determination unit that send out a bearing signal Direction finder in the mobile radio terminal and a separate location device for fine locating the direction-finding signal and thus the mobile terminal after the rough position determination.

Because of this configuration of the monitoring arrangement, after Receipt of an "emergency call message" in a known manner Device of the monitored patient roughly located and at this point Operations team. This team is out with the tracking device equips and can, once it arrives at the appropriate location, the direction finder  the monitored patient's mobile terminal switch to a continuous transmission mode. Alternatively, the switch on of the direction finder transmitter of the fine position determination unit also by the operator of the mobile network itself can be carried out remotely.

In both cases, it is also advantageous if the direction finder from Transmitting part of the mobile radio terminal itself is formed.

The locator is also preferably of a modified type dard cellular device formed, so that the implementation of the Feinpositionsbe take place on the basis of conventional GSM technology, for example can. There are only corresponding software adjustments in the Be drive programs of the mobile terminal devices. As relevant Hardware addition is then only the equipment of the mobile phone Terminal with a directionally sensitive receiving antenna displayed what in a standard mobile terminal by connecting the reception antenna is very easy via the external antenna connection.

Fine localization based on the directionally sensitive receiving antenna can then finally through a fine-resolution field strength display for the received bearing signal can be perfected. Since conventional GSM Standard cell phones in terms of hardware with a field strength measuring device are provided, only a software adjustment is necessary to a high-resolution, numerical display in the display of the end device realize.  

Advantageous developments of the invention will be next hend together with the description of the preferred embodiment of the Invention illustrated with reference to the figures. Show it:

Fig. 1 shows a schematic diagram of a preferred embodiment of the overall arrangement, and

FIG. 2 shows a simplified functional block diagram of the patient-side components of a modified arrangement according to FIG. 1.

In Fig. 1 is a patient monitoring device 1 for monitoring and. Determining the location of a pacemaker patient P ge shows.

The patient P has a pacemaker 2 with an electrode lead 2 a which leads to the heart H and which form the implanted part of the arrangement 1 . The electrode line 2 a is also a sensor for cardiac activity as a physiological parameter and stimulation electrode. The implanted pacemaker 2 is connected to a body signal processing unit 3 via a telemetry connection (not shown in the figure) and both directly and via a second data path via the body signal processing unit to a parameter monitoring unit 4 . A switching device 5 is arranged downstream of the output of the parameter monitoring unit 4 . Furthermore, the pacemaker 2 and the body signal processing unit 3 are connected to an interface device 6 . The interface device 6 is connected via a data connection and the switching unit 6 is connected to a mobile telephone 7 via a control signal connection. This is also a manually operated switch 7 a assigned (which in practice will be formed by a corre sponding function key of the mobile phone itself). The aforementioned components form a patient unit 1A .

The mobile telephone 7 is also an element of a GSM mobile radio network 1 B, to which a plurality of base stations also belong, of which three adjacent base stations 8.1 to 8.3 are shown in the figure. These each include a base transmission station (BTS = Base Transceiver Station) 8.1 a, 8.2 a or 8.3 a and a base station controller (BSC = Base Station Controller) 8.1 b, 8.2 b or 8.3 b. At the level of the switching subsystem, in the example shown, the base stations 8.1 and 8.2 are assigned one and the same mobile switching center (MSC = Mobile Switching Center) 9.1 , and the base station 8.3 is assigned a different MSC 9.2 . All three base stations 8.1 to 8.3 an operation and maintenance center (OMC = operation and maintenance center) 10 is assigned. The distribution of functions between the BTS / PSC, the MSC and the OMC is specifically defined in the respective system and does not require any general explanation here. The only requirement here is that the OMC 10 is assigned a base station coordinate memory 10 a in which the geographic position data of all base stations of the network 1 B are stored, and that the OMC is used for central registration of the measured transit times and the detected diversity assignments is formed at the base stations. Finally the network part 1 B also includes a second mobile phone shown in the figure, namely, a patient monitoring station 1 C associated terminal. 11

The centerpiece of the patient monitoring center 1 C is a central computer 12 which is bidirectionally connected to the terminal 11 (which here symbolizes a plurality of terminals required in practice) and is also connected on the input side to the OMC 10 . The central computer 12 are also a coordinate buffer memory 13 , a runtime buffer memory 14 for the measured runtime values, an antenna assignment buffer memory 15 for the detected antenna assignments of the base station (s) with respect to the terminal device 7 and a plurality of PC workstations, for which is again symbolically represented only by a PC 16 . Finally, the patient monitoring center is assigned emergency response personnel, who are symbolized in the figure by the ambulance 17 and can also be used via the mobile radio network 1 B, which is not shown in detail in the interest of clarity.

FIG. 2 is a simplified functional block diagram of the patient-side part 1 A ′ of a patient monitoring arrangement modified compared to FIG. 1, which shows only the functional components essential for the explanation of the embodiment of the invention. In contrast to the schematic diagram in FIG. 1, the functional units that are to be assigned to the body signal processing unit and the parameter monitoring unit are integrated in the pacemaker itself.

The pacemaker 200 has a largely known structure and is of a type that enables at least ventricular stimulation and the detection of ventricular cardiac signals. For this purpose, it comprises a battery 201 for power supply, a stimulation pulse generator 203 connected on the output side via an output stage 202 to the ventricle electrode 2 a placed in the ventricle of the heart H, and an input stage 204 connected on the output side to the electrode 2 a. The pacemaker control functions are summarized in the figure in control block 205 , the programming inputs 205 a for external programming of the pulse rate and amplitude as well as for activating additional functions, for example of tachycardia termination pulse sequences.

The input stage 204 (in addition to the control block 205 ) is followed by a heart signal buffer 206 and a heart rate determination stage 207 , in which recorded heart signals (IEGM = intracardial electro grams) are temporarily stored and also processed to determine the current heart rate. Furthermore, the pacemaker 2 'comprises a rate limit value memory 208 with two memory areas 208 a and 208 b for an upper and a lower rate limit value and a rate comparator unit 209 connected on the input side to the memory 208 and to the heart rate determination stage. On the output side, both the heart signal buffer 206 and the heart rate determination stage 207 and the rate comparator unit 209 are connected to a pacemaker-side telemetry transmission unit 210 a.

The pacemaker battery 201 is assigned a battery state detection unit 211 in a manner known per se, and the output stage 202 is assigned an electrode impedance detection unit 212 and an impulse amide detection unit 213 , which are likewise known per se. Limit units 214 for the battery voltage, 215 for the electrode impedance and 216 for the pulse amplitude and a comparator unit 217 to 219 are respectively assigned to and arranged after the detector units 211 to 213 . The outputs of the comparator units 217 to 219 are connected to the telemetry transmitter unit 210 a. A pacemaker-friendly telemetry receiver unit 210 b is connected to the programming inputs 205 a of the control block 205 . The pacemaker-side telemetry units 210 a, 210 b are - like the external units (see below) - designed for long-range telemetry with a range of 1 to 2 meters.

An external patient device 7 'comprises a largely conventionally constructed mobile phone 700 in the form of a GSM module and a (together with the implanted transmitting and receiving unit 210 b and 210 a) a bidirectional telemetry path to the pacemaker realizing transmitting and receiving unit 701 a , 701 b. It also includes a buffer memory 702 with this associated memory access control 703 for the temporary storage of data received via the telemetry path and an interface supporting the transmission protocol of the respective mobile radio network (for example PCMCIA card) 704 , which has a coding unit 704 a, for connection to the mobile telephone part 700 and for converting the data formats of the data to be transmitted to the patient monitoring center 1 C ( FIG. 1) and the programming data received from them.

Finally, the patient device comprises a control stage 705 for the automatic control of an emergency call, the input side unit to the telemetry receiver 701 b, on the output side to the phone part 700 and the interface 704 and is input and output side connected to the memory access controller 703rd Finally, a manually operated emergency dialing switching unit 706 is provided for manually triggering an emergency call, which is also connected to the telephone part, the memory access control and the interface. An identification data memory 707 connected to the interface 704 contains invariable device and patient identification data.

With reference to both embodiments of FIGS. 1 and 2 of the actual core of the present invention will now be discussed in more detail. The mobile phones 7 , 700 are equipped with a special function. In the Mo biltelefone namely a direction transmitter 300 is integrated, which can be activated due to a remote control to be explained in more detail. After activation in a continuous transmission mode, this direction finder of the 300 transmits a direction finding signal which is on a GSM-based frequency. The direction finder 300 can thus be formed by the transmission part of the mobile telephone 7 , 700 itself. An intermittent fixed-frequency signal for locating the mobile telephone 7 , 700 is transmitted by means of a locating device which is also to be explained in more detail. The power of this signal should be set according to the remaining battery capacity of the energy supply of the mobile radio terminal 7 , 700 . Likewise, the repetition rate of the intermittent fixed frequency signal according to the remaining capacity of the power supply of the mobile phone 7 , 700 must be adjusted so that on the one hand a sufficiently strong and sufficiently repeated signal is emitted, but on the other hand, a certain minimum operating time can still be guaranteed.

For the fine position determination according to the invention, a locating device 310 cooperates with the direction finder transmitter 300 , which - as indicated in FIG. 1 - is again a mobile phone. As a modifi ed standard mobile phone, the locating device 310 can be connected via the external antenna connection 311 to a directionally sensitive receiving antenna 312 , which is used for bearing the signal sent by the direction finder transmitter 300 . For an accurate indication of the direction of the position transmitter 300 to the locating device 310 , the latter is modified in terms of software so that the telephone display realizes a fine-resolution, numerical field strength indicator 313 for the received direction signal.

The aspects of the function of the embodiment according to FIGS . 1 and 2 which are relevant to the invention are explained below; Details of the pacemaker functions (including the telemetry function) and the data transmission in a mobile radio network are assumed to be known from the prior art. Furthermore, it is also assumed that the mobile radio link also has a voice channel in the usual way in addition to the means for data transmission.

In the ongoing operation of the pacemaker 2 or 2 ', the heart rate and the parameter monitoring unit 4 are permanently by the body signal processing unit 3 or - in the specific example of FIG. 2 - by the heart rate determination stage 207 , the rate limit memory 208 and the rate comparator unit 209 the function of the pacemaker - according to FIG. 2 through the stages 211 to 219 specifically with regard to the battery voltage, pulse amplitude and electrode impedance - monitored. If it is found in the result of one of the limit value comparisons that a relevant measured value has left the permissible range, the signal characterizing this circumstance in the embodiment according to FIG. 1 directly activates the mobile telephone 7 through the switching device 5 . The process includes the automatic switch-on of the phone, the choice of a (in an internal, not separately shown memory of the phone part) pre-stored emergency number and the transfer of a data string stored in the pacemaker 2 via the interface 6 after the connection has been established.

In the modified embodiment according to FIG. 2, the telemetry transmitter unit 210 a is automatically activated by an output signal of one of the comparator units 209 , 217 , 218 or 219 , which reflects an inadmissible value of one of the monitored variables. Under control of the control block 205, the latter then transmits an activation signal and a predetermined (primary) data string, which specifically comprises the IEGM read out from the cardiac memory 206 and the current value of the heart rate available at the output of the cardiac rate determination stage 207 , to the external patient device 7 '. .

There, the activation signal and the data string are received by the external telemetry receiving unit 701b and fed to the external control stage 705 , and the primary data string - under control by the control stage and the memory access control 703 - is initially stored in the external buffer memory. After switching on the mobile phone 700 and establishing a connection to the called terminal 11 of the patient monitoring center 1 C, the primary data string is read from the buffer memory and supplemented with identification data from the identification data memory 707 to form a secondary data string which encodes in the coding unit 704 a and as an emergency call to the patient monitoring center.

There, the emergency call is received by the mobile phone 11 , and the data string is fed to the central computer 12 and transferred from the latter to a PC work station 13 , where an on-duty cardiologist can perform an immediate evaluation for analyzing the emergency and for determining immediate measures.

In parallel to the data analysis, the determination of running of the location of the emergency patient due to the application of his mobile phone 7 or 700 in one or more of the base stations 8.1 to 8.3 of the GSM network 1 B as well as an evaluation of the ascertained in the system Signallaufzeit- and possibly antenna association data. From the memory 10 a at the OMC 10 , the geographic data of the connection-active base station and those adjacent to this BTC, with respect to the signal propagation time measured values, are read into the coordinate buffer memory 13 . The available runtime data - possibly in terms of their time dependency over a predetermined period - are taken over into the runtime buffer memory 14 . The data, which represent the directional antennas of the base station (s) via which the connection or the transit time measurements were made, are loaded into the diversity memory 15 . With access to the contents of this memory, the central computer 12 calculates the rough position of the mobile phone 7 of the emergency patient according to known navigation algorithms.

If the evaluation of the transmitted data has shown the need for a rescue operation, the emergency services 17 are provided with the rough position information and the evaluation result and can make their way to the patient.

As soon as the emergency services 17 have reached the previously determined rough position of the patient, the tracking device 300 in the form of the mobile phone 310, which is carried by them, activates the direction finder 300 in the mobile phone 7 , 700 of the patient. This sends the direction finding signal, which can be detected with the aid of the location device 310 . The fine position of the patient P can thus be reliably determined and this can be found quickly and reliably even in confusing areas.

As an alternative, at the "fine search" of the patient, the possibility may be provided that the tracking device 300 is not activated 1 B of the emergency services 17, but the operator of the mobile network. A corresponding evaluation system for the bearing signals received by the locating device 310 can also be located there, so that the emergency services 17 can be guided to the patient P by the mobile radio operator via the locating device 310 by voice instructions. For this purpose, the locating device 310 can be operated in a dual-mode operating mode in which a locating mode and a message transmission mode take place alternately.

Finally, it should be pointed out that, in addition to the direction finder 300 in the mobile phone 700, the pacemaker 2 'can itself be provided with an emergency direction finder 301 which can be activated if, for example, patient P with the pacemaker 2 ' and external patient device 7 'accidentally separate from one another be separated.

Claims (12)

1. Arrangement ( 1 ) for patient monitoring, with at least one body sensor ( 2 a) for detecting a physiological parameter and a body signal processing unit downstream of this ( 3 ; 204 , 206 ) and / or for acting on the patient (P) trained therapy device ( 2 ; 2 ') and a mobile terminal ( 7 ; 700 ) designed to transmit data from the body signal processing unit or the therapy device to a monitoring center ( 1 C), which can be operated in a cellular mobile radio network ( 1 B) , which has a plurality of preferably earthbound base stations ( 8.1 to 8.3 ), a base station coordinate storage unit ( 13 ) and a rough position determination unit ( 12 ) connected thereto for rough determination of the patient's location based on one of the current base station connection of the mobile radio terminal rough position information obtained in the mobile radio network is provided i st, characterized by a fine position determination unit, which has a direction-finding transmitter-transmitting direction-finding transmitter ( 300 ) in the mobile radio terminal ( 7 , 700 ) and a separate locating device ( 310 ) for fine-locating the direction-finding signal and thus the mobile radio terminal ( 7 , 700 ) according to the rough position determination. 2. Monitoring arrangement according to claim 1, characterized in that the direction-finding transmitter ( 300 ) is formed by the transmitting part of the mobile radio terminal ( 7 , 700 ) itself. 3. Monitoring arrangement according to claim 1 or 2, characterized in that the direction-finding transmitter ( 300 ) can be switched remotely by the operator of the locating device ( 310 ) in a continuous transmission mode. 4. Monitoring arrangement according to claim 1 or 2, characterized in that the activation of the direction finder ( 300 ) of the fine position determination unit by the operator of the mobile radio network ( 1 B) can be remote controlled. 5. Monitoring arrangement according to one of claims 1 to 4, characterized in that the DF transmitter ( 300 ) emits an intermittent Festfre frequency bearing signal. 6. Monitoring arrangement according to claim 5, characterized in that the transmission power and / or repetition rate of the intermittent fixed frequency signal depending on the remaining capacity of the energy supply of the mobile radio terminal ( 7 , 700 ) are adjustable. 7. Monitoring arrangement according to one of claims 1 to 6, characterized in that the locating device is formed by a modified standard-mobile radio terminal ( 310 ). 8. Monitoring arrangement according to one of claims 1 to 7, characterized in that the locating device ( 310 ) can be equipped with a direction-sensitive receiving antenna ( 312 ) for the direction-finding signal. 9. Monitoring arrangement according to claim 7 and 8, characterized in that the receiving antenna ( 312 ) via the external antenna connection ( 311 ) of the standard mobile terminal ( 310 ) can be connected. 10. Monitoring arrangement according to one of claims 1 to 9, characterized in that the locating device ( 310 ) has a fine-resolution, before preferably numerical field strength display ( 313 ) for the bearing signal to be received. 11. Monitoring arrangement at least according to claim 7, characterized in that the locating device acting as a mobile radio terminal ( 310 ) can be operated in a dual-mode mode of operation, in which a locating operation and a message transfer operation take place alternately. 12. Monitoring arrangement according to one of claims 1 to 11, characterized in that a further direction-finding transmitter ( 301 ) is integrated into the therapy device ( 2 ) designed to act on the patient (P).